POS0927 CORONARY ARTERY CALCIFCATION IN SYSTEMIC SCLEROSIS: EVALUATION OF CARDIOVASCULAR RISK AND CLINICAL OUTCOME
Authors: S. Sciacca, C. Rotondo, A. Corrado, D. Cici, F. P. Cantatore
Journal: Annals of the Rheumatic Diseases (2022)

Background The primary prevention of cardiovascular disease (CVD) is a priority element of the worldwide health care agenda. An increased risk of CVD and CV mortality has been shown in lots of studies conducted on patients affected by inflammatory and autoimmune diseases. A routine evaluation of CV risk in these patients should be encouraged and in particular cases is recommended. Objectives The aim of this study is to evaluate the presence of subclinical atheromatosis, the CV risk and its performance in a cohort of patients affected by Systemic Sclerosis (SSc) from a single reference tertiary care hospital. Methods Sixty-seven patients with SSc according to the ACR/EULAR 2013 criteria were included. Traditional CV risk factors and SSc related factors were analyzed. Thoracic high resolution computed tomography (CT) was performed, using the quantification of coronary calcium for the study. Furthermore, a doppler ultrasonography of the carotids and the lower extremity arteries was conducted for the detection of subclinical atheromatosis. The CV risk has been calculated through different CV risk scales including the MESA CAC, the Italian Progetto Cuore, the Framingham score, the Score2 and the QRISK3. After conducting a 5-year follow up, CV outcome and electrocardiography abnormalities were examined. Results Calcium artery coronary score &gt; 0 was reported in twenty-eight SSc patients (41,8%). Considering traditional CV risk factors, the multivariate regression analysis showed a correlation with age (OR 1.151 [95% CI 1.06–1.25], P = 0.001) and systemic arterial hypertension (OR 5 [95% CI 1.148–22.357], P = 0.032). Instead, the presence of anti-CENP-B (OR 3.47 [95% CI 1.09–11.06], P = 0.035) and late-onset disease (OR 1.062 [95% CI 1.007–1.119], P = 0.026) were identified as potential specific disease risk factors. The prevalence of ultrasonography atherosclerosis was high: peripheral artery disease (PAD) and carotid plaque were respectively 43% and 41%, and the presence of coronary calcifications was a risk factor for their detection with a OR respectively of 20.39 and 20.49 (p=0.0001). All CV risk scores considered SSc patients in a low risk, except for the QRISK3, whose values were higher in patients with coronary calcifications (18.4±12.6 vs 5.1±4.9, p=0.0001). In 5-years follow up only 1 patient died for CVD and 2 CV events occurred. Electrocardiography anomalies were found in 28.35% of patients, and in particular in 43% of patients with coronary calcifications (OR 3.321 [95% CI 1.094-10.08], P = 0.03). Conclusion Subclinical coronary atherosclerosis seems to be largely observed in SSc patients and may represent an additional risk factor for electrocardiography anomalies and subclinical atheromatosis in other anatomical districts, with no impact on CVD mortality. In our study coronary calcifications well correlated with CV risk score, especially the novel QRISK3 by classifying these patients between low and moderate CV risk. Other studies are needed to support the hypothesis that subclinical coronary atherosclerosis, occasionally detected in thoracic CT, may represent a clinical alert to establish timing and weight of diagnostic and specific treatment protocols for the CV prevention in SSc patients. References [1]Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovasculardisease risk management in patients with rheumatoidarthritis and otherforms of inflammatory joint disorders: 2015/2016 update. Ann RheumDis 2017; 76(1):17–28. [2]Ungprasert P, Charoenpong P. Risk of coronary artery disease in patients with systemic sclerosis: a systematic review and meta-analysis. ClinRheumatol. 2014;33(8):1099-1104 [3]Sanz Pérez I, Martínez Valle F. Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts, quantification of coronary calcium and carotid ultrasonography. Autoimmun Rev. 2018;17(9):900-905 [4]Di Battista M, Barsotti S, Della Rossa A, Mosca M. Cardiovascular burden in systemic sclerosis: QRISK3 versus Framingham for risk estimation. ModRheumatol. 2021; roab011. Disclosure of Interests None declared